OSD Assistive Technology

Requestor Name *

Requestor School *

Phone Contact 360.xxx.xxxx

Best Time/Day for contact

Student Name *

Grade/Special Education Program *

Assistive Technology Request * choose one or more

General information regarding accommodations and/or the use of AT in my classroom or site, i.e. articles, options, brainstorming.
Phone or email consultation re: specific student and possible need for AT.
Funds for student specific purchase of item/equipment under $100.00.
Collaborative consideration of student need for assistive technology devices and services (team meets at site with AT staff to review student needs, environment, tasks, and possible tools). Required for purchases over $100.00.
AT Student Assessment to assist in determining strategies and/or equipment for specific need (e.g. access, writing, communication)
Staff training in specific software, technology or techniques, for example: Clicker 5, text readers or word prediction software, switch training, literacy for non-verbal students, etc.)
AT staff to attend a specific student’s IEP or Evaluation meeting to provide information and help clarify AT needs.
Other:

Additional Notes Anything else you'd like us to know